ApplicationForm

PersonalDetails
ApplicationNumber:

104822025

PostAppliedFor:

LEKHPAL/

DistrictAppliedFor(
):

VARANASI

NameofTheCandidate(
):

ANAMIKASINGH

Father'sName(

):

UDAYPRATAPSINGH

Mother'sName(

):

NEELAMSINGH

DateofBirth():

05/04/1995

Age:

20

AgeMonths:

AgeDays:

27

Gender(
):

Female

Nationality():

Indian

Religion(
):

Hindu

MaritalStatus(
):

Single

UPDomicile(UP):

Yes

AppliedinCategory(
):

General

SkilledPlayerofUP(

?):

No

Gov/ExGovStateEmpofUP(
,

,00

No

?):

CorrespondenceAddress
AddressLine1(
1):

VILLMAJHBITIYA

AddressLine2(
2):

PANDEYPUR

AddressLine3(
3):

VARANASI

District():

VARANASI

State():

UttarPradesh

Pincode():

221002

MobileNo(
):

8115552847

PermanentAddress1(
1):

VILLMAJHBITIYA

PermanentAddress2(
2):

PANDEYPUR

PermanentAddress3(
3):

VARANASI

PermanentAddressDistrict():

VARANASI

PermanentAddressState():

UttarPradesh

PermanentAddressPincode():

221002

PermanentAddressMobileno(
):

8115552847

QualifyingExaminationDetails
Examination
()

YearofPassing
(

Board/School
(
)

RollNumber
(.)

Percentage/Grade(
/
)

10thorEquivalentExamination

2010

UPBOARD

3218210

69.33

12thIntermediate

2012

UPBOARD

2408415

60.80

DoyouhaveanyadditionalQualification?

?:
BSC

2015

MGKVPVARANASI

Yes
12315060029

Haveyouservedinterritorialarmyforminimumperiodof2years?

?:

Haveyouobtained'B'CertificateofNationalCadetCorps?

?:

61.11
No

No

ExaminationcenterDistrictPreferences(
)
Examinationcenterdistrict1(
1):

VARANASI

Examinationcenterdistrict2(
2):

ALLAHABAD

Examinationcenterdistrict3(
3):

LUCKNOW

FeeDetail
FeeApplicable(

):

300

AmountPaid(
):

300

TransactionId(

):

DU25375352

Dateoffeesubmission(
):

10/07/2015

Tab3Saved:

Saved

Declaration
ISOLEMNLYUNDERTAKEtoacceptandabidebythenotification/rulesoftheBoardofRevenue,U.PIherebysolemnlyaffirmthatIhavegonethroughthe
Advertisement&Instructionsandsolemnlydeclareonoaththattheentriesmadebymeintheabovecolumnsaretruetothebestofmyknowledgeandbeliefandif
atanytime,theentriesarefoundincorrect,therecruitmentmayoutrightlybecancelledandsuitableactionmaybeinitiatedagainstme.Iwouldnothaveany
objection.
(
/

/
|

|)

Date:
Version10.00.01